How to Insert Pacemakers?

Tissues are nourished and oxygenated by the blood pumped by the heart. This is how we generate the energy we need to survive. If a problem occurs that affects the heart’s pumping of blood, not only the heart but the whole body is affected. Therefore, the biological electrical system that enables the formation of heartbeats is one of the most important mechanisms in our body.

If there is a problem that affects the formation of electrical impulses in the heart and therefore the heartbeat, pacemakers are placed in the patients. The electrical impulses that the heart needs can be created regularly with pacemakers and delivered to the relevant parts of the heart. Thus, the heart pumps blood to the body at the speed and order it should be. The tissues reach the oxygen and nutrients they need.

The first questions that come to mind of people who are aware of pacemakers are “How are pacemakers inserted?” or “Is there any pain when a pacemaker is inserted?” In this article, we will first talk about the structure of pacemakers, their purpose and duties. Then, we will answer the question “How is a pacemaker inserted?”

You can call us to get detailed information about pacemaker in Turkey, You can make an appointment with Associate Professor Dr. Ömer Uz.

What are Pacemakers?

Pacemakers are advanced technologic devices that ensure that the heartbeat is regular and as it should be. They generally consist of two main parts. The part called the generator (battery) is the part where electrical impulses occur. The part known as the electrode (cable) is the part that connects the generator with the heart. With the help of electrodes, heartbeats are monitored instantly. If these beats slow down or become irregular, the generator part comes into play, generates an electrical impulse and transmits this warning to the heart with the help of electrodes. Thus, the blood pumping function of the heart is virtually guaranteed.

Why is Pacemaker Inserted?

Pacemakers are inserted to support the heart that has difficulty in generating electrical impulses or delivering the impulses they create to the relevant areas. Our cells and tissues are oxygenated by the blood pumped by the heart.  After the blood gives its oxygen to the cells, it takes the carbon dioxide from the cells. It then continues to circulate to be cleaned and re-oxygenated. If there is a disruption in the beating of the heart during this process, the cells cannot be oxygenated properly. While the amount of oxygen in their bodies decreases, the amount of carbon dioxide increases. This can cause the person to experience dizziness and lightheadedness. In some cases, syncope (fainting) may occur. If this situation persists, much more serious health problems may occur. Pacemakers are placed to prevent this condition and to ensure that the blood circulation continues in the healthiest way possible.

How to Insert Pacemaker?

Before the insertion of a pacemaker, patients are given conscious  sedation. Then, local anesthesia is applied just below the left collarbone. Thus, patients do not feel pain and discomfort during the operation. All these processes are performed in laboratory environments that allow special imaging techniques.

How to Implant Permanent Pacemaker?

The pacemaker implantation process is followed by the doctor instantly with the scopic imaging technique. This ensures that the process goes smoothly. After the anesthesia procedure is completed, an average of 4 centimeters incision is made 2 to 3 centimeters below the left collarbone. With the help of this incision, a vein called the subclavian vein is reached. Thanks to the subclavian vein, the electrodes (cables) of the pacemaker are delivered to the relevant parts of the heart. The electrodes are then connected to the pacemaker generator. The generator part of the pacemaker is placed in an area that opens to the left shoulder area. If the person is left-handed, the right shoulder may also be preferred for this procedure. Pacemaker insertion ends after the incision is stitched with special techniques.

How to Implant Temporary Pacemaker?

Temporary pacemakers stay in the patient’s body for a limited time, as can be guessed from their names. This period is on average 10 to 14 days. They are generally used after some heart surgeries while waiting for the temporary damage to the electrical system of the heart to pass. If these damages do not heal, permanent pacemakers are inserted instead of temporary pacemakers. In some emergencies, temporary pacemakers may be used to gain time until a permanent pacemaker is inserted.

Temporary pacemakers, unlike permanent pacemakers, are outside the patient’s body. Only the electrode parts of the pacemaker are inside the body. These electrodes (cables) are delivered to the heart with the help of veins in the groin or neck region. That is, one end of the electrodes is in the heart, while the other end is in the generator outside the patient’s body (in the electrical impulse generating part of the pacemaker).

How to insert Implantable cardioverter-defibrillators (ICD)?

Pacemakers with electroshock feature are inserted almost like permanent pacemakers. However, the insertion process is of course a little more complicated. We talked about these processes in detail in our articles titled “3-wire pacemakers or CRT ” and “Types of Pacemakers”. You can access these articles from the Pacemakers and Shock Devices menu on our site.

How Long Does It Take to Insert a Pacemaker?

Pacemaker implantation takes about 30 minutes. This period may vary from person to person, depending on the type and characteristics of the pacemaker to be inserted. Your doctor will inform you in detail about the duration of the pacemaker implantation.

What Are the Risks of a Pacemaker Implantation?

As with any medical treatment, pacemaker therapy has some risks. The risks that may be encountered when inserting pacemakers are generally avoidable risks. In other words, if the physician who wears the pacemaker is experienced enough and the environment in which the pacemaker is placed is suitable enough for the procedure, most of these risks can be practically zeroed. 

Risks of implantation of a pacemaker may include:

• Infection formation.
• Vascular injury, damage to vessels.
• Clot formation.
• Disconnection of electrodes (pacemaker leads) from their insertion.
• Damage to the lung.

How Long Will It Take To Recover After Pacemaker Insertion?

After the permanent pacemaker is implanted, the patients are hospitalized for one day. During this period, the patients’ pulse, blood pressure and the functionality of the pacemaker are checked regularly. The operation area is taken care of. This ensures a good start to the healing process.

After the pacemaker is inserted, patients can return to their daily lives within 10 to 15 days, according to the doctor’s recommendation. During this period, the incision made during the procedure heals. Stitches are removed on average 10 days after the operation. The maintenance of the operation area should not be interrupted during the mentioned 10 to 15 day period. During the healing process, patients should carefully follow the doctor’s recommendations.

What Should be Considered After a Pacemaker is Inserted?

There are some issues that need to be considered after a pacemaker is inserted. If these issues are taken into consideration, the healing process will be much more comfortable and trouble-free. Thus, the pacemaker can perform its functions without any problems. Among the things to be considered after the implantation of a pacemaker are the following:

• During the first 10 days after the operation, the application area should be regularly dressed. This area should be kept as clean as possible.
• Arm movements not recommended by the doctor should be avoided for 1 to 2 months after a pacemaker is inserted. This is important so that the pacemaker cables do not become dislodged.
• Weight should not be carried using the right arm if the area where the procedure is performed is on the right, and the left arm if it is on the left. This situation should be avoided for at least 3 months according to the doctor’s recommendation.
• One should not lie on the side with the pacemaker for 1 month after the pacemaker is inserted.
• Patients with pacemakers can use mobile phones and similar electronic devices. However, when using these devices, the other hand should be preferred instead of the hand on the side with the pacemaker. As far as possible, electronic devices should not be brought closer than 15 centimeters to the pacemaker.
• If possible, security guards should be asked to search by hand when entering shopping malls or airports. Because metal detectors or X-ray rays used in such areas may affect the operation of the pacemaker. Security guards are instructed to manually search for patients with pacemakers.
• Driving is not recommended for approximately 15 days to 1 month after a pacemaker is inserted. Afterwards, the car can be used according to the doctor’s recommendation.